Thefts of Drugs Prompt Schools To Tighten Up

After returning to school from a long weekend earlier this year, Tim
Jarboe entered the nurse's office at the Georgia middle school where he
is the principal to do the weekly medicine count. He gasped when he saw
the medicine cart with its lock cut off and drawers of pills pried
open.

"Oh, no," Mr. Jarboe remembers thinking. "Not again."

In the second such incident since September, the medication bottles
of 16 students were missing from Coile Middle School in Athens, Ga.
That meant that more than 430 pills of Ritalin and Adderall, two
stimulants commonly used to treat students with attention deficit
hyperactivity disorder, were in the wrong hands.

Following the latest incident over Presidents' Day weekend last
month, Mr. Jarboe put a silent alarm system in the nurse's office. And
now he is looking into installing video cameras outside that office to
keep watch after hours.

"You hate to spend tax dollars that we could be using to buy
textbooks," Mr. Jarboe said. "But we feel like we have to. It's a big
responsibility handling these drugs that are used as street drugs."

As evidence mounts that the abuse of controlled substances used to
treat ADHD is on the rise, growing numbers of school administrators are
feeling the weight of that responsibility. More abuse has meant more
schools victimized by thefts of such drugs—especially
methylphenidate, the generic name for Ritalin. And that has prompted
more administrators to take precautions similar to those at Coile
Middle School.

A school district in Pennsylvania has put motion detectors outside
the nurse's office to record activity after hours.

The Maine legislature passed a law last year mandating that
noncertified school medical workers have a certain number of hours of
training before they can distribute drugs.

And schools nationwide are no longer keeping drugs in a nurse's desk
drawer or unlocked wooden cabinets, but are instead resorting to
sturdier medicine cabinets, restricting keys to nurses' offices to
their nurses and principals only, and counting pills daily to keep
better track of them.

Security Needs Grow

The role of schools in the identification of students with attention
problems, and in the use of medications such as Ritalin to treat them,
have embroiled educators in controversy over the past decade. School
officials have been caught up in clashes over such issues as whether
attention deficit disorder and ADHD are overdiagnosed, whether
medications are overprescribed, and whether schools are pushing parents
to medicate their children unnecessarily.

But many educators and school nurses, regardless of their personal
feelings about medications such as Ritalin, agree that the need for
secure policies and storage of those substances is paramount.

Between 1990 and 1997, the production of Ritalin increased 650
percent, according to the U.S. Drug Enforcement Administration. It is
also among the top 10 drugs in pharmaceutical theft, the DEA
reports.

Doctors prescribe drugs such as Ritalin, Adderall, and a new
extended-release medication called Concerta to students with attention
disorders to help them focus and control their impulses. But when
crushed and snorted—or crushed, mixed with water, and
injected—the same stimulants provide a moderate, "cocaine-like"
high, experts say. A study released last month by the Massachusetts
Department of Health showed that 12.7 percent of high school students
surveyed reported having used Ritalin as a recreational drug at least
once in their lives. The Massachusetts study shows Ritalin abuse
peaking in the 10th and 11th grades.

Around the country, methyl-phenidate pills are being sold on the
street for $2 to $20 each, authorities say. Students report using the
drugs to help them stay up late and study, and refer to the pills as
"Vitamin R" or "Smarties." Most Ritalin hits the black market because
students with prescriptions give away pills or sell the drug to
students without prescriptions.

Schools Seek Help

One national consultant on school security said school
administrators used to balk at being asked how they were protecting
their nurses' offices.

"Now that the issue is more high-profile, schools are hungry for
information," said Kenneth S. Trump, the president of National School
Safety and Security Services, a Cleveland-based consulting firm.

School officials should assess the security of their medicine
supplies by looking at the types of cabinets in which they are secured,
and the locations of the cabinets in relation to doors and windows, Mr.
Trump said. When school districts design new buildings, he added,
officials should consider placing the nurse's office away from windows
or outside doors for security reasons.

In one school whose security arrangements he assessed, Mr. Trump
said, medications were kept in the main office in a small cabinet on
the wall next to the windows.

"It was kind of an advertisement: 'Look what we have here,'" he
recalled.

Mr. Trump said a lock on the medicine cabinet doesn't guarantee
security. "You could lift the cabinet off the wall and take it with
you," he noted.

At the Center Drive School in the 440-student Orrington school
district in eastern Maine, security measures for controlled substances
started with the very design of the school building, said Debi Blank,
the school's nurse.

"The nurse's office is centrally located and opens with a different
key than what opens any other room in the building," she said.

Robin Fox, the nursing supervisor in the Souderton, Pa., school
district, said that in her 6,400-student district, motion detectors
have been placed outside the school nurses' offices.

But while motion detectors and video cameras are being employed more
frequently to combat drug thefts in schools, they are still not in
widespread use for that purpose, Mr. Trump said.

Mr. Jarboe said he never thought he would have to resort to such
measures. There are still no suspects in the two incidents in his
Clarke County, Ga., middle school.

"We were stumped by all of this," said Mr. Jarboe, who said he now
refers to the nurse's office as "the vault."

"You kind of realize schools aren't built to be a secure facility,"
he added. "In our school, we encourage the public to use our gym and
facilities. Our driveways and parking lots are always open. It's a real
challenge."

Camera Stirs Complaints

A video camera mounted in the hallway outside the nurse's office
helped William Tennent High School in Warminster, Pa., identify a
student as a suspected Ritalin thief. In January, the student allegedly
stole 300 Ritalin pills after tampering with the locks in the nurse's
office.

But in Tacoma, Wash., an elementary school principal provoked
criticism when she installed a hidden camera after some Ritalin
disappeared from the nurse's station. Members of Jefferson Elementary
School's staff, joined by the American Civil Liberties Union,
complained that the principal had violated privacy laws by installing
the camera.

Last October, the school removed the camera, which had been aimed at
the locked medicine cabinet through a hole poked in an eye chart.

"If you want advice on how to catch a Ritalin thief, the
video-camera idea didn't work very well for us," said James Shoemake,
the superintendent of schools in Tacoma. "We are not a real good
example."

Mr. Shoemake said that when the video camera was installed in the
school nurse's lounge area, the camera's audio function was turned on
inadvertently.

"It was in a nurse's lounge where a certain level of privacy was
expected," Mr. Shoemake said. "Now the main security we are using is
lock and key. It seems obvious, but we are just limiting the number of
keys."

Other districts have limited the number of people who have access to
medications and who can distribute them to students.

"Some schools allow non- nurses to hand out medicines, or nurses
delegate, but not in our district," said Ms. Fox of the Souderton
district in southeastern Pennsylvania.

Some states, including Illinois and New Jersey, require only
certified nurses to distribute medications. But even in such states,
policies differ on whether schools are exempt from the law, and some
have policies requiring that certified nurses dispense drugs except in
"emergencies."

Administrators say there aren't always enough nurses to go around.
So some districts delegate the duty to health technicians or even
trusted secretaries. A study conducted last year by the Maine
legislature showed that 63 percent of school staff members in the state
who distributed drugs had had two hours of training or less in
dispensing the pills. In response, the legislature passed a measure
require schools to train staff members who have not received
instruction in properly distributing medication.

Late last year, the Texas board of education passed a series of
suggestions for schools on the distribution of medications such as
Ritalin. The board recommended, but did not require, that each school
come up with policies and procedures for storing psychotropic drugs.
The board also suggested limiting the role of distributing the drugs to
nurses only.

At the time, Children and Adults with Attention
Deficit/Hyperactivity Disorder, a national advocacy group known as
CHADD, said the Texas board had violated the rights of students with
ADHD.

"The terms proposed present a severe crisis to children attending
schools in many rural settings where a medical practitioner may not be
on the school premises," Beth A. Kaplanek, the national board president
of CHADD, said in a letter to the Texas state board. "Schools must
facilitate rather than interfere with the administration of
appropriately prescribed medications where such indications are
necessary for a child to benefit from education."

Keeping Count

Schools around the country say they usually have systems for
tracking the distribution of medications, much like the arrangements in
hospitals or pharmacies.

Many school nurses say they will not accept pills delivered to them
by students, for example. Instead, a parent must bring any prescription
medications to the nurse. Pills are often counted in front of parents
at the time of delivery.

"We are required to count all controlled substances, such as
Ritalin, just as we do in the hospitals at the end of shifts with
narcotics," said Diane G. Armstrong, a nurse at Bernardsville Middle
School in Bernardsville, N.J. "The parent and the nurse count together
and sign that the count is accurate and date it."

And if any pills are left at the end of the school year?

John McClure, a nurse at Monger Elementary School in Elkhart, Ind.,
said his school district has discovered a way to wash its hands of the
problem. When disposing of unused medication at the end of the year, he
will flush the medicine down the toilet. "With witnesses and two
signatures," he added.

New forms of methylphenidate that are released in the body over time
allow students to avoid taking a midday dose at school altogether. If
such time-released formulas grow in popularity, they may help ease
schools' responsibility for handling controlled substances, some
experts and school officials say.

"I think the situation will improve with the new sustained-release
formulas," Ms. Fox said. "Parents give it to their kids before they get
to school. That cuts out the school."

In May of 2000 the Drug
Enforcement Agency studied the use of Ritalin in the United States.
Read the agency's congressional
testimony on its findings concerning the prescribing practices for
Ritalin and the potential for and actual abuse of the drug.

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